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Appeal a denied prescription prior authorization with Claude

WorkedEvidence: Described by posterPosted Last checked

Claude drafted a Reddit poster's appeal of a Zepbound prior authorization denial using portal records, and a 1-year approval followed.

How to use this

  1. Tap Copy prompt.
  2. Open Claude.
  3. Paste it into the message box.
  4. Send it, then read the answer before acting on it.
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Prompt

Recreated prompt

The source didn't share its exact prompt, so we wrote one from what it describes. The result shown is the source's, not ours.

What the prompt labels mean

The person didn't share their exact words, so we wrote this from what they described. We haven't tested it, and they didn't use this exact version.

Here is my insurance denial letter for a prior authorization of my ongoing prescription. What specifically would be needed to prove I meet the criteria stated in the denial? I'll add my visit summaries, clinical notes and prescription history next.

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Optional stronger version

Our rewrite with extra checks. The poster didn't test it.

Before you start, ask me 1–3 short questions about the details below and wait for my answers. Once I've answered, confirm the plan in one line and run the whole task start to finish.

Goal: Help me write an insurance appeal for a denied prescription, matched to the exact criteria in the denial letter.

Questions to ask me first:
- What does the denial letter say the plan needs?
- Which records can you download from your patient portal?
- Is your doctor's office aware of the appeal and willing to sign or send records?

Inputs (fill in or confirm):
- Denial letter: [DENIAL]
- Plan's coverage criteria: [CRITERIA]
- Visit summaries, notes and prescription history: [RECORDS]
- Appeal deadline and how to submit: [DEADLINE / PORTAL]

Rules:
- List each criterion and the record that proves it, quoting the record.
- Don't add medical claims that aren't in my records.
- Keep my doctor informed, and suggest a doctor's letter if the plan requires one.
- Remind me to remove personal details I don't need to share.
- List the attachments in order.

Checkpoint: Show me the criteria-to-evidence table before drafting the letter.

If you get stuck: If a criterion has no supporting record, tell me what to ask my doctor for.

Verify before you finish: Check every quoted record and date against my files.

Output: An appeal letter and an attachment checklist.

Done when: I've submitted a complete appeal before the deadline and saved a copy.

AI tool

Claude

Outcome

A Reddit poster's new employer plan denied a doctor's prior authorization for an ongoing Zepbound prescription because specific documentation was missing. The doctor's office was too busy to appeal, so the poster uploaded the denial letter to Claude and asked what was needed to meet the stated criteria. After adding visit summaries, clinical notes and prescription history from MyChart, Claude flagged more criteria to highlight, drafted the appeal letter and listed the attachments. The poster proofread it, made minor changes and submitted it through the online portal. After more than 3 weeks, the plan approved a 1-year authorization.

Evidence: Described by posterThe person describes what happened in words, without screenshots or video.

Source

Posted
by Reddit user (r/Zepbound)
Last checked
Method:
How we verify

https://www.reddit.com/r/Zepbound/comments/1uwskoh/insurance_appeal_success_anthembcbs/

Context: The source date is estimated from the Reddit post ID, since the page shows only a relative age. The doctor prescribed the medication and filed the original request.

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